Furious about the forum
CMAJ 1997;157:139
I am greatly distressed that CMAJ has given Dr. Mamoru Watanabe a platform from which to speak on behalf of the National Forum on Health ("A call for action from the National Forum on Health," CMAJ 1997;156:999-1000 [full text / résumé]).
Although it is well within the realm of public policy to decide what percentage
of the gross domestic product from public monies should be spent on health care, it is unacceptable and intrusive for government to decide how much of their own money individual citizens can or should pay for health care or anything else. This fundamental flaw in our public policy was never even addressed by the forum, even though more than 28% of all money spent on health care in Canada involves private-sector spending.
The forum has apparently failed to notice the remarkable strife that has arisen at the provincial level, largely because the federal government has withdrawn billions of dollars in funding. The results include growing waiting lists, unemployed nurses and angry confrontations between physicians and provincial governments. Considering this, I am astounded that Watanabe concluded: "We must expand publicly funded services to include all medically necessary services." He added that "the evidence suggests that increasing the scope of public expenditure may be the key to reducing total costs." I am not an economist, but it is absolutely preposterous to propose that, in the face of massive federal cutbacks, the scope of public expenditures be increased.
I concur entirely with the support for more focused spending on children's health, particularly for children living in poverty, and a commitment to evidence-based medicine. Overall, however, the National Forum failed to bring any new thinking to the very real fiscal problems facing medicare in Canada. The forum may have served its Liberal masters well, but it failed to address or even acknowledge the serious problems front-line clinicians witness every day.
Derryck Smith, MD
President
British Columbia Medical Association
Vancouver, BC
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